Alfred-Armand-Louis-Marie Velpeau (1795-1867) was a French Surgeon.
Velpeau was one of the most accomplished French surgeons and anatomists of the nineteenth century. Rising from rural poverty to the chair of clinical surgery in Paris, he combined clinical experience with an extraordinary literary output spanning operative surgery, regional anatomy, obstetrics, embryology and diseases of the breast. He was renowned for his breadth of knowledge, anatomical descriptions and willingness to revise established opinion when confronted by new evidence.
His name survives with the Velpeau bandage, the Velpeau projection, and quadrilateral space of Velpeau. His wider contributions include early descriptions of suppurative axillary disease, painful crepitant tenosynovitis, leukaemia and chronic destructive dermatoses of the nipple.
Biography
- Born May 18, 1795 at Brèches, Indre-et-Loire, France, the son of a rural farrier who practised veterinary medicine. [aka 29 Floréal, Year III of the French Republican calendar]
- 1816 – Entered the Hôpital Général de Tours. Studied clinical examination, anatomy, autopsy and experimental medicine under Pierre-Fidèle Bretonneau (1778–1862)
- 1818 – Appointed premier élève at the Hôpital Général de Tours.
- 1819 – Qualified as an officier de santé, permitting him to practise medicine within the department without holding a university medical doctorate.
- 1820 – Moved to Paris to continue his medical education. Worked with anatomist Jules Cloquet (1790–1883)
- 1821 – Awarded the École pratique prize in anatomy and physiology and appointed aide d’anatomie at the Paris Faculty of Medicine.
- 1823 – Graduated MD from the Faculty of Medicine of Paris with his Thèse sur quelques propositions de médecine defended under the presidency of René Laennec (1781–1826)
- 1824 – Successful in the first series of examinations for the restored concours d’agrégation and appointed agrégé de médecine with his thesis An tuberculorum crudorum in pulmonibus certa diagnosis? possibilis curatio?
- 1828 – Passed the competitive examination for the Paris hospital surgical service and was appointed chirurgien du Bureau central des hôpitaux.
- 1830 – Appointed surgeon at the Hôpital de la Pitié. Competed, initially without success, for a professorial chair at the Paris Faculty of Medicine.
- 1832 – Elected resident adjunct member of the Académie royale de médecine
- 1834 – Appointed professor of clinical surgery at the Faculty of Medicine of Paris, succeeding Alexis Boyer (1757–1833).
- 1835 – Took charge of the surgical clinic at the Hôpital de la Charité, where he taught and practised for the remainder of his career.
- 1843 – Elected to the Académie des sciences, section of medicine and surgery, succeeding Dominique-Jean Larrey (1766–1842).
- 1849 – Served as president of the Académie nationale de médecine.
- 1860 – Returned to Brèches, contributed substantially to the reconstruction of the village church and acquired a country residence at Antony
- 1862 – Delivered a funeral oration for his former teacher Bretonneau
- 1863 – Served as president of the Académie des sciences.
- Died in Paris on August 24, 1867 aged 72, buried in Montparnasse Cemetery.
Medical Eponyms
Velpeau bandage
The Velpeau bandage is a thoracobrachial immobilisation apparatus in which the flexed arm is secured against the chest, traditionally with the hand directed towards the opposite shoulder. The original roller-bandage construction combined support of the elbow, fixation of the upper limb, and corrective positioning of the shoulder girdle.
1826 – Velpeau reported the use of compression in acute inflammation of the limbs, particularly inflammation involving the synovial, tendinous and articular structures of the hand, forearm and foot. He recommended broad, even pressure, initially moderate and progressively increased, with the roller carefully moulded to the contours of the limb. This was a therapeutic compression bandage and was not yet the thoracobrachial shoulder apparatus.
Velpeau Bandage. 1839
1839 – In the second edition of Nouveaux éléments de médecine opératoire, Velpeau described and illustrated his “bandage de l’auteur” under the treatment of fractures and dislocations of the clavicle.
Velpeau devised the bandage initially for sternoclavicular dislocation and subsequently used it for acromioclavicular dislocation and fractures of the clavicle, acromion, scapula and neck of the humerus.
The injured hand was placed on the opposite shoulder and the elevated elbow brought in front of the lower sternum. The humerus, supported against the thorax, acted as a lever to carry the injured shoulder upwards, backwards and outwards. Oblique turns passed from the unaffected axilla across the injured shoulder and beneath the elbow; horizontal turns then fixed the arm and forearm against the chest.
A second roller impregnated with dextrin could be applied over the first, forming an almost immovable casing in which the elbow was supported and prevented from moving forwards, backwards or laterally. Padding could be placed above the clavicle, between the arm and thorax, or in the axilla according to the injury being treated.
Mais je suis parvenu à construire un bandage, au moyen d’une simple bande…aux luxations sterno-claviculaires pour lesquelles je l’avais d’abord imaginé…Une nouvelle bande, bien imbibée de dextrine… fait de ce bandage une espèce de sac inamovible. Velpeau 1839
I devised a bandage constructed from a single roller, originally intended for sternoclavicular dislocations… A second roller, well impregnated with dextrin, transforms the apparatus into a rigid, fixed casing. Velpeau 1839
Velpeau referred to the methods of Petit, Duverney, Boyer, Boettcher, Brasdor, Meslier, Flamant and Ravaton as having fallen into disuse because they did not achieve their intended purpose. The Velpeau bandage was provided as an alternative to both the complex Desault apparatus and the insufficiently stable simple sling.
1963 – Michael C. Hall reviewed Velpeau’s original method and observed that many different swaddling and adhesive-tape arrangements had subsequently been called Velpeau bandages. Modern Velpeau slings preserve the general adducted arm-to-chest position but omit the corrective diagonal turns, clavicular compression and dextrin reinforcement of Velpeau’s original roller-bandage apparatus.
Associated terminology
- Velpeau bandage – The original roller-bandage apparatus described in 1839.
- Velpeau position – The injured arm adducted across the chest, with the elbow flexed and elevated and the hand resting near or upon the opposite shoulder.
- Velpeau sling – A later simplified appliance maintaining the arm against the thorax, usually without reproducing the original roller sequence.
- Velpeau dressing – A broader and less exact later term, sometimes used for a reinforced or semi-rigid form of the bandage.
Velpeau axillary view / Velpeau projection
Velpeau axillary view 1967
The Velpeau axillary view is a modified axial radiograph of the glenohumeral joint obtained while the injured arm remains adducted and immobilised in a sling.
1967 – Bloom and Obata described the Velpeau axillary view, a modified axial radiograph of the glenohumeral joint obtained while the injured arm remained immobilised in a Velpeau bandage or shoulder sling. The seated or standing patient leaned backwards 20–30 degrees over the image receptor, while the beam was directed vertically through the shoulder.
The technique was designed for patients in whom pain, fracture, soft-tissue injury or sling immobilisation prevented the arm from being abducted for a conventional axillary projection. Its principal purpose was to demonstrate glenohumeral alignment and reduce missed posterior shoulder dislocations.
This is a derivative eponym. The view was named because it was obtained while the patient remained in a Velpeau bandage or equivalent arm-to-chest sling.
2020 – Cruz et al evaluated the clinical utility of additional axillary and Velpeau radiographs after standard shoulder trauma imaging. The additional views rarely changed management overall but were useful when glenohumeral stability remained uncertain, particularly in occasional otherwise unrecognised posterior dislocations.
Quadrilateral space of Velpeau
The quadrilateral space of Velpeau, also termed the quadrangular space or foramen humerotricipitale, is an intermuscular passage in the posterior shoulder. It is bounded by the teres minor, teres major, long head of triceps and surgical neck of the humerus, and transmits the axillary nerve and posterior circumflex humeral vessels.
1825 – In Traité d’anatomie chirurgicale, ou anatomie des régions, Velpeau described an interval between the teres major and subscapularis that became an approximately quadrilateral opening near the humerus:
Entre le grand rond et le subscapulaire se trouve un espace qui s’élargit progressivement en se rapprochant de l’humérus. Cet espace devient un foramen approximativement quadrilatéral, délimité en haut par le bord antérieur de l’omoplate et le subscapulaire, en bas par le grand rond, en arrière par le chef long du triceps sural et en avant par le col de l’humérus. Du tissu conjonctif remplit cet orifice, par lequel passent l’artère et le nerf axillaires. Velpeau 1825
Between teres major and subscapularis muscles lies a space that gradually widens as it approaches the humerus. This space becomes a quadrilateral foramen…Connective tissue fills this opening, through which the axillary artery and nerve pass. Velpeau 1825
Velpeau described his boundaries from the axillary aspect and differ in orientation from the modern posterior-view definition, but identify the same neurovascular passage. Modern anatomy defines the space boundaries as:
- superior: teres minor;
- inferior: teres major;
- medial: long head of triceps;
- lateral: surgical neck of humerus.
- structures traversing the space: axillary nerve, posterior circumflex humeral artery and vein.
Quadrilateral space of Velpeau
Quadrilateral space syndrome
Quadrilateral space syndrome is a rare neurovascular compression disorder involving the axillary nerve, the posterior circumflex humeral artery, or both within the quadrilateral space. It typically causes poorly localised posterior or lateral shoulder pain, focal tenderness over the space, paresthesia, and sometimes weakness or denervation of the teres minor and deltoid. The symptoms may be provoked by forward flexion or sustained abduction and external rotation.
1967 – Bernard R. Cahill began investigating unsuccessful operations performed for presumed thoracic outlet syndrome. He noted that some patients demonstrated dynamic obstruction of the posterior circumflex humeral artery when the shoulder was abducted and externally rotated.
1983 – Cahill and Palmer described and named Quadrilateral space syndrome. They associated the symptoms with dynamic compression of the posterior circumflex humeral artery and axillary nerve, demonstrated by positional arteriography, and reported surgical decompression in 18 patients.
Dynamic compression in quadrilateral space syndrome. The posterior circumflex humeral artery is patent with the arm by the side but becomes occluded during abduction and external rotation. Adapted from Cahill and Palmer, 1983.
2019 – Mahjoub and colleagues reported acute traumatic quadrilateral space syndrome following scapula fracture. The traumatic form was caused by compression of the axillary nerve by a displaced scapular fracture fragment. Reduction, fixation and neurolysis were followed by recovery of axillary nerve function within ten weeks.
Velpeau disease (hidradenitis suppurativa)
Hidradenitis suppurativa is a chronic, recurrent inflammatory disease of the follicular unit in intertriginous skin. It produces painful nodules and abscesses that may recur, form draining tunnels, and heal with fibrosis and scarring.
1833 – In his article Aisselle, Velpeau described phlegmons superficiels ou tubériformes arising close to the dermis of the axilla. They appeared as circumscribed plaques or small furuncle-like masses, sometimes solitary but more often clustered. Velpeau associated them with friction and irritation of the sebaceous follicles and noted their slow course, occasional severe pain and usual progression to suppuration
…sous la forme de plaques fort circonscrites ou de petites masses furonculaires, quelquefois uniques, plus souvent agglomérées en certains nombres. Fréquemment amené par les frottemens, par l’irritation des follicules sébacés de la région, par le défaut de propreté…Sa terminaison naturelle est la suppuration. Velpeau 1833
They usually appear as sharply circumscribed plaques or small furuncle-like masses, sometimes solitary, but more often clustered in groups. Frequently brought about by friction, irritation of the sebaceous follicles of the region, and lack of cleanliness…Its natural outcome is suppuration. Velpeau 1833
Resolution was uncommon, and some inflammatory foci persisted as hard, mobile nodules. The account is generally regarded as the earliest recognised clinical precursor of hidradenitis suppurativa, although Velpeau did not describe the complete modern syndrome of recurrent lesions, tunnels and scarring.
1854–1865 – Aristide Verneuil (1823-1895) attributed the disease to inflammation of the sweat glands and developed the term hidrosadénite phlegmoneuse, giving rise to the alternative eponym Verneuil disease.
Key Medical Contributions
Crépitation douloureuse des tendons (aï)
Painful crepitation of the tendons was Velpeau’s term for an acute, frequently effort-related tenosynovial disorder producing pain, swelling and palpable or audible crepitus in the distal forearm. His descriptions involving the abductor pollicis longus and extensor pollicis brevis are more consistent with crepitant tenosynovitis or intersection syndrome than with classic de Quervain stenosing tenosynovitis.
1825 – In Traité d’Anatomie chirurgicale ou des Régions, Velpeau described a “very singular disease” of the fibro-synovial canal containing the long abductor and short extensor tendons of the thumb. He had observed ten or twelve patients with swelling, heat, pain on thumb movement and distinct crepitation produced by moving the thumb while grasping the swollen tendon sheath.
1837 – In Traité complet d’anatomie chirurgicale, he localised the disorder to the fibro-synovial grooves of the lower radial forearm. It often followed effort, and the tendon crepitus could be mistaken for the crepitation of a fracture.
1841 – In Leçons orales de clinique chirurgicale, Velpeau published his clinical lecture on crépitation douloureuse des tendons. He described painful crepitation of tendon sheaths after effort, especially around the long abductor and short extensor of the thumb, and noting the Gascon term aï / ay.
Je l’ai désignée sous le nom de crépitation douloureuse des tendons… Les paysans de la Gascogne donnent à cette affection le nom de l’aï…le trajet des muscles indiqués (long abducteur et court extenseur du pouce)… si on embrasse la partie gonflée avec une main, et qu’avec l’autre on fasse mouvoir le pouce, on sent et on entend une crépitation bien évidente…Velpeau 1841
I have designated it by the name painful crepitation of the tendons… The peasants of Gascony give this affection the name aï…the course of the muscles indicated, the long abductor and short extensor of the thumb… if one grasps the swollen part with one hand and moves the thumb with the other, one feels and hears a very evident crepitation Velpeau 1841
1895 – Fritz de Quervain (1868-1940) separately defined chronic stenosing tendovaginitis at the radial styloid. Unlike Velpeau’s acute crepitant condition, de Quervain disease is characterised by constriction of the first dorsal compartment and typically does not produce marked crepitus.
Altération du sang (early description of leukaemia)
Leukaemia is a clonal malignancy of blood-forming cells characterised by abnormal proliferation of leucocytes in the bone marrow and peripheral blood. Velpeau’s observation is retrospectively compatible with leukaemia or another myeloproliferative disorder. No definite subtype can be assigned as blood counts and microscopic cellular examination were not available.
1825 – In Altération du sang, Velpeau reported the illness and autopsy of a man who developed progressive left-sided abdominal enlargement and a palpable mass after the age of 60. At autopsy, the spleen weighed 10 livres (approximately 5 kg) and the liver was twice its usual volume. The vascular system contained dark, abnormally viscous blood:
Le sang n’était point coagulé; il n’était pas fluide non plus; sa consistance avait celle de la bouillie, un peu plus épaisse que celle du pus bien lié...…on pût se demander si ce n’était pas plutôt de la matière purulente qui remplissait les vaisseaux. Velpeau 1825
The blood was not coagulated, but neither was it fluid; its consistency was that of gruel, slightly thicker than well-formed pus…one might ask whether the vessels contained purulent matter rather than blood. Velpeau 1825
Velpeau remarked that the alteration was so profound that one might question whether the vessels contained purulent material rather than blood. His account is regarded as one of the earliest clinicopathological descriptions retrospectively compatible with leukaemia, although he neither demonstrated leucocytosis nor defined the disease as a distinct haematological entity.
Chronic nipple dermatosis (Paget disease of the nipple)
Mammary Paget disease is an intraepidermal adenocarcinoma involving the epidermis of the nipple and usually the areola. It presents as a persistent unilateral eczematous, crusted, eroded or exudative lesion and is usually associated with underlying ductal carcinoma in situ or invasive breast carcinoma
1840 – In Maladies du sein chez la femme, Velpeau described two women with longstanding crusted disease of the nipple arising years after lactation. He regarded the lesions as intermediate between chronic eczema and psoriasis. The crusts were thick, fissured and adherent, and their removal produced bleeding:
The scabs… were rather thick, cracked, adherent, and generally any attempt at their removal was followed by a bloody oozing.
One patient improved with topical treatment and the other underwent excision of the nipple after other measures failed. Velpeau also described impetiginous eczema spreading from the nipple across the breast and noted that pain, erythema, thickening and induration could lead clinicians to suspect cancer.
1854 – In his expanded traité des maladies du sein et de la région mammaire, Velpeau continued to distinguish eczematous nipple disease from the manifestations of mammary carcinoma. He did not identify chronic nipple dermatosis as a distinct malignant process or clearly associate it with underlying breast cancer.
1874 – Sir James Paget (1814-1899) described approximately 15 women in whom a chronic eczema-like eruption of the nipple and areola preceded the development of breast carcinoma. His recognition of this repeated association established the clinical entity subsequently known as Paget disease of the nipple.
Umbilical cord and birth asphyxia
Velpeau examined the transition from placental to pulmonary respiration and the practical management of the umbilical cord. He distinguished a pale, poorly perfused form of neonatal asphyxia from a congested or cyanotic form.
1829 – In his traité complet de l’art des accouchemens, Velpeau discussed umbilical circulation and neonatal asphyxia. He observed that cord pulsation persisted while placental respiration continued and advised that the cord should not be cut too early when pulsation remained and placental attachment was intact.
He distinguished pale “white asphyxia”, associated with weak circulation and failure to breathe, from congested “blue asphyxia” following difficult labour or cord compression. His recommendation to bleed cyanotic infants through the divided cord is obsolete, but his observations document an early attempt to understand the transition from placental to pulmonary respiration.
Anaesthesia from “chimera” to ether
General anaesthesia transformed surgery by permitting major operations without conscious pain. Velpeau’s famous 1839 statement captures the apparent impossibility of painless surgery before ether, but it should be paired with his enthusiastic acceptance of ether anaesthesia in 1847.
Eviter la douleur dans les opérations est une chimère qu’il n’est plus permis de poursuivre aujourd’hui. Instrument tranchant, et douleur en médecine opératoire, sont deux mots qui ne se présentent point l’un sans l’autre à l’esprit du malade, et dont il faut nécessairement admetre l’association. Velpeau 1839
To eliminate pain from surgery is a *chimera that can no longer reasonably be pursued. In the patient’s mind, the knife and pain are inseparable, and their association must be accepted. Velpeau 1839
In this context, chimère means an unrealistic hope, unattainable project or fanciful illusion. Although the word derives from the mythological Chimera, Velpeau was not making an extended allusion to the fire-breathing creature.
1847 – Following the introduction of ether anaesthesia in Paris, Velpeau rapidly revised his opinion. After observing operations performed without pain, he told the Académie des sciences that there was “no longer any room for doubt” and predicted that ether inhalation would have consequences extending beyond surgery to physiology, chemistry and psychology.
On le voit, il n’y a plus moyen d’en douter, la question des inhalations de l’éther va prendre des proportions tout-a-fait imprévues. Velpeau 1847
There is no longer any room for doubt: ether inhalation will assume entirely unforeseen proportions. Velpeau 1847
Major Publications
- Velpeau AALM. Thèse sur quelques propositions de médecine. 1823
- Velpeau AALM. An tuberculorum crudorum in pulmonibus certa diagnosis?; possibilis curatioo? 1824
- Velpeau A. Traité d’anatomie chirurgicale, ou Anatomie des régions, considérée dans ses rapports avec la chirurgie; ouvrage oneé de quatorze planches. 1825 [Tome II] [English translation: 1830 Volume I, Volume II]
- Velpeau A. Altération du sang. Archives générales de médecine 1825; 3(7): 462–463. [leukaemia]
- Velpeau A. Mémoire sur l’inflammation aiguë des membranes synoviales, tendineuses et articulaires des doigts, de la main et de l’avant-bras, des orteils et du pied: et sur l’utilité du bandage compressif dans ces maladies. Nouvelle bibliothèque médicale, 1826 [Velpeau bandage]
- Velpeau A. Sur la résorption du pus et sur l’altération du sang dans les maladies. Revue médicale française et étrangère. 1827; 2: 216–240. [leukaemia]
- Velpeau A. Nouveau manuel d’anatomie descriptive. 1828 [Translations: New elements of operative surgery; Nuevos elementos de medicina operatoria; Nuovi elementi di medicina operatoria]
- Velpeau AALM. Traité complet de l’art des accouchemens, ou tocologie théorique et pratique. 1829, [A complete treatise on midwifery. Translated by C D Meigs, 1831]
- Velpeau AALM. Nouveaux éléments de médecine opératoire. 1832 [Tome II, Tome III and Atlas]
- Velpeau AALM. Embryologie ou ovologie humaine. 1833
- Velpeau A. Aisselle, phlegmons, abcès. In Dictionnaire de Médecine ou répertoire général des sciences médicales, Béchet, Paris, 1833; II: 91–101 [hidradenitis suppurativa]
- Velpeau A. Des convulsions chez les femmes; pendant la grossesse, pendant le travail et après l’accouchement. 1834
- Velpeau AALM. Sur la rétraction des doigts. Gazette médicale de Paris. 1835; 2s(3): 511. [Dupuytren contracture]
- Velpeau AALM. Traité complet d’anatomie chirurgicale, générale, et topographique du corps humain. [Tome II] 1837 [De Quervain disease]
- Velpeau AALM. Nouveaux éléments de médecine opératoire, accompagnés d’un atlas 1839 [Tome II, Tome III, Tome IV]
- Velpeau A. Maladies du sein chez la femme In: Leçons orales de clinique chirurgicale faites à l’Hôpital de la charité. 1840: 68-96 [Tranlsation: A treatise on the diseases of the breast and mammary region, 1840]
- Velpeau AALM. Traité des maladies du sein et de la région mammaire. 1854 [Translation: A treatise on the diseases of the breast and mammary region] 1856 [Paget’s disease of the nipple]
References
Biography
Eponymous terms
- Hall MC. The Velpeau bandage. Can Med Assoc J. 1963 Jan 12;88(2):92-3
- Bloom MH, Obata WG. Diagnosis of posterior dislocation of the shoulder with use of Velpeau axillary and angle-up roentgenographic views. J Bone Joint Surg Am. 1967 Jul;49(5):943-9.
- Cahill BR, Palmer RE. Quadrilateral space syndrome. J Hand Surg Am. 1983 Jan;8(1):65-9.
- Dunn PM. Dr Alfred Velpeau (1795–1867) of Tours: the umbilical cord and birth asphyxia. Arch Dis Child Fetal Neonatal Ed 2005;90:F184–F186.
- Kampen KR. The discovery and early understanding of leukemia. Leuk Res. 2012; 36(1): 6-13.
- Thomas X. First contributors in the history of leukemia. World J Hematol. 2013; 2(3): 62-70
- Revista Trauma. Epónimos. Trauma Fundación Mapfre Vol. 23 (2012), Supl 1
- Mahjoub S, May F, Zaraa M, Mahjoubi Y, Abdelkefi M, Mbarek M. Acute traumatic quadrilateral space syndrome following scapula fracture. J Clin Orthop Trauma. 2019 May-Jun;10(3):518-521.
- Sivanand A, Alhusayen R, Piguet V, Alavi A. “Hidradenitis Suppurativa” Is a Historical Term That Does Not Reflect the Current Understanding of Disease Pathogenesis. J Cutan Med Surg. 2020 Nov/Dec;24(6):644-645.
- Cruz SA, Castillo H, Chintapalli RTV, Adams OE, Morgan VK, Koh JL, Lee MJ, Shi LL. The Clinical Utility of Additional Axillary and Velpeau Radiographs in the Evaluation of Suspected Shoulder Trauma. J Orthop Trauma. 2020 Aug;34(8):e261-e265.
La Leçon d’anatomie de Velpeau à la Charité. 1864 [Public Domain]
Eponym
the person behind the name
BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocol 4e| Eponyms | Books |
